Questions:

[ProSense]

Some people are misrepresenting the current House bill to the point of calling for it to be killed. If the bill is that bad, how exactly does anyone think a robust public option is going to change that? Also, if fear of the state opt out is so strong, how does anyone think Kucinich's single payer amendment is going to change that? Are people expecting Republican governors going to set up single payer?







edited for clarity.

[boppers]

1. Because mandated coverage, without a PO, is taxation without representation.

It's basically a tax on the working class, with the money going to corporations.

[ProSense]

2. That has nothing to do with the questions. The bills include a public option. n/t

[phleshdef]

17. LOL! What? You still have elected representatives regardless of whats in the bill.

[boppers]

26. My elected representatives are giving money to the East India company.

..and mandating that I buy tea.

[uponit7771]

25. The Bill has a public option for those without insurance or those who insurance falls short IIRC

[boppers]

27. I don't qualify. Do you?

I fall into the group of "makes good money, but doesn't have an employer option", and would rather go without health care than pay into some insurance industry scam.

If it was legal, I'd also drop my car insurance, because I DON'T NEED IT, but the state thinks that corporations need to have my money to cover the morons who *do* need it.

edit:typo

[PretzelWarrior]

28. you're cuckoo. spend more time reading your own sig pic

and less time saying stupid stuff.

[Tom Rinaldo]

3. Maybe some Democratic Governors would set up Single Payer

Jerry Brown might do something like that if he becomes California's Governor. THAT would be a good "market test" of single payer.

[ProSense]

4. States are already doing that. All Jerry Brown has to do is

sign it.

State proposals

California's Legislature has twice passed a state-level single payer bill, SB 840, "The California Universal Healthcare Act" (authored by Sheila Kuehl), in 2006 and again in 2008.<21><22><23> Both times, Governor Arnold Schwarzenegger vetoed the bill.<24> State Senator Mark Leno re-introduced "The California Universal Healthcare Act" again in March 2009, newly renumbered as SB 810.<25> SB 810 was set for its first legislative hearing on April 15, 2009.

In April 2008, the Illinois House of Representatives' Health Availability Access Committee passed the single-payer bill HB 311, "The Health Care for All Illinois Act,"<26> favorably out of committee by an 8-4 vote.<27>

Several single-payer state referendums and bills from state legislatures have been proposed, but so far all have failed to pass, including (states where the debate is also current) California as early as 1994,<28> Massachusetts in 2000, and Oregon in 2002.<29>

In 2009 the House of Representatives Education and Labor Committee approved an amendment to the House health care bill, which would allow individual states to adopt a single-payer Medicare-for-all-style health plan. The amendment was proposed by Democratic Congress member Dennis Kucinich of Ohio. The Kucinich Amendment received support from some conservatives supporting states rights as it would allow states more freedom to explore various models including, but not limited to, single payer.<30>

link

[Tom Rinaldo]

5. Since your thread was named Questions figured might as well ask....

"In 2009 the House of Representatives Education and Labor Committee approved an amendment to the House health care bill, which would allow individual states to adopt a single-payer Medicare-for-all-style health plan."

So how is that different than what Schwarzenegger vetoed? If states can set up single payer on there own already, how does what Kucinich proposed add anything new to the equation?

[ProSense]

6. The Kucinich amendment is basically an ERISA waiver

State Single Payer Amendments

Kucinich Amendment Grants ERISA Waiver for Single Payer States.
Sanders Senate Amendment Would Expand Support for Single Payer States

The Center for Policy Analysis worked closely with Congressional staff to craft the two amendments to health reform legislation that offer the greatest prospects for single payer supporters.

Summary

Some state and local governments that have attempted to expand health care coverage have been successfully challenged in court under the terms of the Employee Retirement Income Security Act of 1974 (ERISA). ERISA pre-empts states from enacting legislation if it is “related to” employee benefit plans. It reserves that right to the federal government. Section 514 of ERISA states that Title V (Administration and Enforcement) and Title IV (Fiduciary Responsibility) of ERISA “shall supercede any and all State laws insofar as they may… relate to any employee benefit plan.” There is no provision for an administrative waiver of these rules.

The Kucinich amendment to HR 3200, approved by a recorded vote of the House Education and Labor Committee, would remove this barrier for states that have enacted and signed into law a single payer system.

What the Amendment Does

The Secretary of Labor, in consultation with the Secretary of Health and Human Services, would be authorized and required to waive the ERISA pre-emption (Sec. 514) for states that have enacted a state single payer system. In this case, the Secretary could decline to grant the waiver only under extraordinary circumstances. The system would have to meet requirements, and the Secretary could revoke the waiver if it fails to do so.

The state single payer system is defined as a non-profit program of the state for providing health care to all residents. A single state agency would finance and administer the provision of comprehensive benefits that meet or exceed the standards for coverage and quality described in HR 3200, and assure free choice of health care providers. Private insurance that duplicates this coverage would be prohibited. Health maintenance organizations could operate on a non-profit basis if they also own their facilities and provide services directly. The system would not result in greater costs to the federal government. At the same time, the federal government would maintain the equivalent level of support as provided to other states, accounting for variations such as population and demographics. States could seek planning and start-up funds.

What the Amendment Does Not Do

A state single payer amendment was proposed by Senator Sanders. It is more detailed than the Kucinich amendment because it would cover matters beyond the jurisdiction of the House Education and Labor Committee. These include: Dedicated funding for planning and implementation grants; Specific allocations of funds from existing federal health programs, and waivers to permit coordination with those programs; Quality assurance and health professional training programs associated with other federal programs.

Click here to download Kucinich ERISA waiver

Click here to download Sanders amendment

Click here to download above summary of Kucinich amendment

[Armstead]

8. That answers my question below...I think

If I interpret that correctly, there is an automatic potential "kill" of state single payer in those provisions. Kucinich believes the health reform should at least give the states the ability to go around that.

[ProSense]

9. "there is an automatic potential 'kill' of state single payer in those provisions" What? n/t

[Armstead]

15. This....

ERISA pre-empts states from enacting legislation if it is “related to” employee benefit plans. It reserves that right to the federal government. Section 514 of ERISA states that Title V (Administration and Enforcement) and Title IV (Fiduciary Responsibility) of ERISA “shall supercede any and all State laws insofar as they may… relate to any employee benefit plan.” There is no provision for an administrative waiver of these rules.

The Kucinich amendment to HR 3200, approved by a recorded vote of the House Education and Labor Committee, would remove this barrier for states that have enacted and signed into law a single payer system.

[ProSense]

19. That's true, but ERISA is basically about not changing the employer based system.

A lot of states are enacting their own plans.

UNIVERSAL HEALTH CARE

According to the National Conference of State Legislatures (NCSL), a number of state legislatures have considered health care reform affecting all state citizens. Most of the proposals have been based on a “single-payer” model, which consolidates all payers – Medicare, Medicaid, state programs, and commercial insurers – into a single administrative structure.

In 2003, California and Maine enacted legislation designed to provide insurance coverage to broad segments of their state populations that does not rely on a single-payer system. Instead, these states have introduced an employer-based system of universal health care. Hawaii has had a universal health care access law since 1974. Vermont introduced the Vermont Health Access Plan in 2000. These programs are described below.

California

California’s governor signed SB 2, the “Health Insurance Act of 2003,” on October 5, 2003. It uses an employer “play or pay” model that requires employers with 20 or more employees to pay into a purchasing pool if they do not provide health care coverage for their employees. The law applies to large employers, those employing 200 or more persons, as of January 1, 2006. It applies to medium employers, those with 20 to 199 employees, beginning on January 1, 2007. Employers with 20 to 49 employees will not have to comply until a tax credit is enacted.

Employees who are not provided health care through their employer can obtain coverage from the State Health Purchasing Program. The program will be funded through the employer fees and enrollee contributions, which cannot exceed 20% of the employer fee. For an enrollee whose wages are less than 200% of the federal poverty level, the contribution cannot exceed 5% of the employer fee. The act authorizes a loan from the state’s general fund to pay for program start up costs.

To be eligible for coverage, an enrollee must work at least 100 hours per month for an individual employer and have worked for that employer at least three months. The insurance provided by the program may require copayments, coinsurance, and deductibles.

The act requires the Department of Health Services to implement a state Medicaid (Medi-Cal) premium assistance program, as long as federal financing is secured. The program would pay employer-based health care premiums for those eligible for Medi-Cal.

Maine

Maine’s governor signed LD 1611, “An Act To Provide Affordable Health Insurance to Small Businesses and Individuals and To Control Health Care Costs,” on June 13, 2003. This law provides Maine’s residents with expanded access to health care coverage in two ways. First, it expands the state’s Medicaid program, MaineCare, by increasing the eligibility income limits.

For those who do not qualify for MaineCare, the law creates the Dirigo Health program, which offers health care coverage primarily for employees of small employers and uninsured individuals, with premium subsidies available to people with incomes below 300% of the federal poverty level. Higher income individuals can buy into the program by paying the full premium. Employers (1) are expected to contribute up to 60% toward the premiums, with employees paying 40%, and (2) must certify that at least 75% of employees working 30 hours or more per week and without other coverage are enrolled in Dirigo Health.

The law establishes a new agency to run Dirigo Health with a governing board. The agency will determine the services and benefits to be provided, as well as cost sharing obligations for participants, such as premiums and copayments. The agency is required to publicize the program and must contract with health insurance carriers to provide the coverage. The program must be running by October 1, 2004.

A one-time federal payment via an enhanced Medicaid match will fund Dirigo Health’s first year of operations. In subsequent years, the state expects the program to be self-supporting through a combination of additional Medicaid federal matching funds and “savings offsets” that all state insurers are required to pay. The Dirigo Health board will determine the offset amounts, which will be based on the annual percentage of premiums collected by each insurer.

For residents with pre-existing conditions, the law creates a high-risk pool and directs Dirigo Health to develop disease management protocols for these enrollees.

Additional detail on Maine’s Dirigo Health is available in OLR’s Research Report 2003-R-0494 (copy enclosed).

Hawaii

Hawaii’s Prepaid Health Care Act of 1974 requires all employers to offer health care coverage (Haw. Rev. Stat. § 393-1, et seq. ). An employer must provide health care benefits for each employee who works 20 hours or more a week (excluding seasonal employees). The employer must pay for at least 50% of the premium, provided that an employee’s contribution is no more than 1. 5% of his salary. The mandatory health care benefits include hospital, surgical, medical, diagnostic laboratory, maternity, and substance abuse benefits.

The law is possible because of a statutory exemption from the federal Employee Retirement Income Security Act of 1974 (ERISA). ERISA regulates employee benefit plans, including life, health, disability, and pension plans. Employers are not required to provide employee benefits under ERISA, but if they do, they must meet ERISA requirements for plan participation, funding, and vesting, as well as plan administration standards for reporting, disclosure, and fiduciary duties. While ERISA was being debated in Congress, legislators successfully amended it to exempt the Hawaii Prepaid Health Care Act, thus allowing Hawaii to require employers to provide health care coverage to their employees (29 U. S. C. § 1144(b)(5)). Because no other state has this ERISA exemption, no other state can establish such a program.

Vermont

Vermont Health Access Plan. Vermont’s Public Act 1995-14 authorized the Vermont Health Access Plan (VHAP). The legislation increased the state cigarette tax by $ 0. 24 to fund the state’s share of the program cost. It also raised revenue by assessing hospitals and nursing homes for the program’s first three years.

VHAP has three components: (1) funding health care services for lower-income residents whose access to care is limited, in part, by their lack of insurance; (2) providing a prescription drug benefit to lower income elderly or disabled residents on Medicare; and (3) implementing a managed care delivery system to improve access, service coordination, and quality of care for program beneficiaries.

Any uninsured adult age 18 or older with income below 150% of the federal poverty level (FPL) may be eligible for VHAP coverage. Parents and caretaker-relatives with incomes under 175% of FPL may also be eligible. Elderly or disabled individuals with incomes under (1) 175% of FPL may be eligible for pharmacy coverage through the VHAP-pharmacy program and (2) 225% of FPL may be eligible for state-funded pharmacy coverage.

A fee-for-service program called VHAP-Limited provides basic benefits for a person’s first month or two of coverage. VHAP-Limited coverage runs until the person is added to the state’s managed care program, called Primary Care Plus (PC-Plus). PC-Plus coverage includes doctor visits, prescriptions, specialist visits, emergency room care, inpatient hospital care resulting from an emergency or urgent care admission, outpatient care, laboratory tests and X-rays, family planning, mental health and substance abuse services, and home health care.

Depending on a person’s income, he may have to pay a program fee every six months. Copayments apply for most services. VHAP covers about 50% of prescription costs.

2005 Vermont State Health Plan. Pursuant to Public Act 2003-53, the Vermont Department of Health is developing a state health plan that must be delivered to the legislature by January 15, 2005. The plan must (1) include health promotion, health protection, nutrition, and disease prevention priorities for Vermont; (2) identify resources available and needed for achieving the health goals; and (3) identify those areas of the state that need additional resource allocation.

link

[Tom Rinaldo]

12. So about this "ERISA waiver"...

Just trying to add two plus two here (math is sometimes harder than it looks):

"Some state and local governments that have attempted to expand health care coverage have been successfully challenged in court under the terms of the Employee Retirement Income Security Act of 1974 (ERISA). ERISA pre-empts states from enacting legislation if it is “related to” employee benefit plans."

Kucinich wants the Feds to be able to waive the above. OK, Califronia passed Single Payer but the Terminater terminated it. Without the Kucincich amendment can I assume someone could have challenged California's Single Payer systeme in court over the ERISA matter if the Governor had instead signed it into law?

[Armstead]

7. I may be wrong but I think the House bill kills off that possibility

Kucinich is mad because he wants it to include the ability for states to do universal coversge.

He is smart enough not to get angry if that were not to be negatively affected by the new health care bill in some way.

It would be interesting to know if the House proposal would actually prevent states from doing it.

[ProSense]

10. There is no such thing. Now, what about the questions?

This isn't a discussion about the merits of the Kucinich amendment. What about the actually health care bill? Why would that bill, which some people want to see killed, be considered a good bill simply by adding a robust public option and/or the Kucinich amendment.

[Armstead]

16. here's my answer

Any legislation that forces people to buy a private product -- while basically allowing "the market" to continue to operate freely is wrong.

The only way the government should be mandatiung anything is if the government provides the service as a public entity tghat is accountable and is not driven by profit.

A bill that forces people to buy insurance without actually providing the insurance on a basis that is guaranteed to be afforddable (i.e. sliding scale) is worse than no bill at all.

Congress could have taken a positive step if they at least had simply promised reform of the existing system through much stronger regulation of the insurance industry without mandates -- and did n ot sdo it in a way that set expectations high and also is likely to preempt any further reforms such as a real public option or single payer.

[Tom Rinaldo]

18. The final bill hasn't been written yet and I'm still undecided

"Don't let the perfect be the enemy of the good" is often quoted, but just as true is this: "Don't let the marginal be the enemy of the good".

The health care reform bill of 2009/2010 most likely is the last express train to Clarksville for a good long time to come. It is still too soon to stifle concern over the details it does or does not contain while the amendment process is still ongoing.

Yes it's a cheap shot cliche to repeat that the current House version is 1900 pages long, but 1900 pages can obscure lots of details, both good and bad. Regarding the Kucinich Amendment, based only on what I am reading here it seems to be an attempt to resolve a block in current law to States pasing Single Payer, rather than an attempt to correct a problem introduced in the current reform legislation. But that raises an interesting point. Why did Pelosi bother to strip it out of the bill? My simple answer is; as a favor to special interests who want to kill all chances for Single Payer in America. If we don't have the juice to include that type of voluntary provision in the House's legislation, what other compromises to the center right will the House bill make, either now or before this whole thing is through?

If the Kucinich amendment is included in the House bill, there is a fighting chance we can get it into law because there will be great pressure on moderates to not kill whatever bill finally emerges and get blamed for killing all health care reform as a result. As a stand alone measure brought up at some future date the Kucinich Amendment most likely wouldn't stand a prayor of a chance against powerful special interests. So the question for me becomes then, why at every fork in the road, when opportunity is knocking and a choice is made between taking a real step toward Medicare for all, or doing something patchwork that protects the power of the private insurers instead , it is the right fork ultimately taken?

We are now down to expecting an estimated 6 million enrollees in a public option under the House plan; with premiums likely higher than the private plans offered because of compromises already made that curtail economy of scale for the government program and which lock in a cherry picker's advantage for private insurers whose clients will likely be overall healthier than those who qualify for a public option. At some point our reform will devolve into a set up that discredits public health insurance as a failed experiment not to revisited again in many of our lifetimes. Are we at that point with the legislation now? I don't know, but I do know that it has always been assumed that the House bill would overall be more progressive than whatever comes out of the Senate, and as a result more progressive than whatever finally gets passed into law.

[Armstead]

21. Heree's what frosts me...(Among others)

The theory of the "opt out" clause is to give the states freedom to do nothing and leave the current mess in place if they want to.

So -- if states rights is the issue -- why the heck not also allow them the freedom to do MORE if they choose?

The only answer I can come up with is hypocract...And a craven cave in tghe leadership to the insurance industry.

Maybe there is another answer to that question, but dang if I can find it. It seems to be symbolic of this whole reform. Instead of really helping people, it's giving the insurance industry a huge gift, with a few little strings attached.


'

[Tom Rinaldo]

22. It seems to me somewhere along the line a decision was made;

...soft peddle any push for anything remotely to do with actual government run health insurance in return for some degree of cooperation by some special interests and those in Congress beholden to them, and just consider that the price to pay to get some type of health care reform passed in this Congress.

I don't think anyone was really counting on such a hard push back from the Democratic activist base after the right wing tantrums of August supposedly drove a stake through so-called "government take over of health care". Now the dance seems to be how little of a public option and tip of the hat to progressives can we get away with giving to keep them from bolting and upsetting the deal that seemed to already be in place?

[Armstead]

23. My fear is that they are going to get rolled in this devils bargain

If they pass something that relies on the good graces of the insurance industry, they (and we) are in for a rude awakening.

Everytime they fall for that, we end up as bad, or worse, than when we started.

[Tom Rinaldo]

24. Yup. It is the very nature of the insurance industry to rig the game table...

All of the policies they write are designed to ultimately take more money from clients than they will need to shell out in return. THAT IS THEIR BUSINESS MODEL They are exactly like Casinos, they always come out ahead and THEY make sure that the rules will guarentee that. This is who the Democrats are trying to cut deals with, AND we promised the dealer we will not bet heavy on a good hand, out of respect for the dealer's profit margin. So no talk of single payer, not a whisp of it, and maybe a tiny little public option that hardly anyone qualifies for except mostly people the health insurance industry is pretty much happy to continue doing without anyway.

[Avalux]

11. "Some" have two different agendas.

They're either Pukes who don't want anything to pass, or Progressives who don't think the bill is strong enough.

It's not a bad bill and once passed, can be built from and made stronger. It's a foot in the door, so to speak.

[Prism]

13. A frank answer

The fundamental problem with current reform is that the mandates put a disproportionate burden on the working and middle classes through costly premiums. A robust public option, at least my definition, would include affordable premiums that anyone could opt into.

Under the current mandate system, not enough people are even eligible for the public option, and premiums are going to absolutely destroy many working families who are currently living paycheck to paycheck.

The entire problem with this health reform is that the Democrats were predisposed to protecting the health insurance industry and constitutionally opposed to any kind of taxation to pay for these programs. The result is this mandate system that puts a crushing, crippling burden on working Americans while pouring profits into the health insurance industry and leaving the wealthiest Americans almost completely responsibility free for this reform.

Not only that, but the current bills give insurance companies years to concoct schemes that will maximize profits and perform end-runs around whatever restrictions and obligations Congress puts into place. Look at the credit card industry. Congress gave them a mere nine months, and they went to work screwing as many people as humanly possible. Imagine what the insurance companies can do with three to five years.

It would be unfair not to note that there are some good things in this reform. Including pre-existings in the system is an unadulterated good. However, we have to look at the overall cost and effectiveness of this plan in the context of the entire nation.

Right now, the costs are destructive, and this bill is a time bomb. They need to start over. What this will do to the middle and working classes should be transparent and worrying to all. Instead, we've entered a culture where the politicians are looking for a "win" and if all of this blows up in ten years, well, that'll be someone else's problem.

It's unacceptable.

[Bluenorthwest]

14. Without the Kucinich Amendment states can not establish

a state single payer plan. Not California under Brown, not my state of Oregon, which probably would do so, not any state. I'd like us to be able to do our best, instead of the mediocre results of the Beltway crowd's best. We could do far better.
Bernie Sanders specifically addressed this subject in detail on the Hartmann show on Friday. Without that waiver, States are locked in to the national mediocrity with no way out.

[ProSense]

20. A few points

When Cantwell proposed an amendment to allow states to set up their own public options, similar to her state's, people rejected it based on the fact that 50 individual public options would be unable to effectively compete with the insurance companies. This was also the reason people rejected the Carper opt in plan. It's also the reason why people are skeptical about the opt out plan.

The amendments:

(Sanders)

A state single payer amendment was proposed by Senator Sanders. It is more detailed than the Kucinich amendment because it would cover matters beyond the jurisdiction of the House Education and Labor Committee. These include: Dedicated funding for planning and implementation grants; Specific allocations of funds from existing federal health programs, and waivers to permit coordination with those programs; Quality assurance and health professional training programs associated with other federal programs.

(Kucinich)

The state single payer system is defined as a non-profit program of the state for providing health care to all residents. A single state agency would finance and administer the provision of comprehensive benefits that meet or exceed the standards for coverage and quality described in HR 3200, and assure free choice of health care providers. Private insurance that duplicates this coverage would be prohibited. Health maintenance organizations could operate on a non-profit basis if they also own their facilities and provide services directly. The system would not result in greater costs to the federal government. At the same time, the federal government would maintain the equivalent level of support as provided to other states, accounting for variations such as population and demographics. States could seek planning and start-up funds.

Kucinich Amendment

In July 2009, the House Education and Labor Committee approved an amendment authored by Kucinich to its version of the Obama health insurance bill by a vote of 27-19, with 14 Democrats and 13 Republicans voting for it.<29> The amendment empowers the Secretary of Health and Human Services to waive the federal law that pre-empts state law on employee-related health care, the Employee Retirement Income Security Act, in response to state requests.<30> It has been speculated that the amendment's bipartisan support was for its appeal to states' rights in supporting progressive legislation.<29> In the past, states attempting to enact single-payer reforms have been successfully sued and stopped under ERISA.<30> Progressives hope that this law's passage will spur a path to a single-payer system for the United States, as newly unbound states would show single-payer's success, as Saskatchewan did for Canada.<29> The Kucinich Amendment does not appear in the merged House bill, which he now regards as a "sham" and "a bailout for insurance companies".<31>

link

Now what happens when a state waives the federal law, and then establishes something other that a single payer plan, such as an HMO-operated non-profit?

Also what happens to the national plan when states opt out?

[eridani]

29. It just needs the good parts to be taken out and repackaged n/t